Provider Demographics
NPI:1861760274
Name:ITANI, MAHMOUD M (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:M
Last Name:ITANI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E LUGONIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2550
Mailing Address - Country:US
Mailing Address - Phone:909-307-6964
Mailing Address - Fax:909-798-3967
Practice Address - Street 1:800 E LUGONIA AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2550
Practice Address - Country:US
Practice Address - Phone:909-307-6964
Practice Address - Fax:909-798-3967
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist